Pott’s disease, surgical case series and literature review
DOI:
https://doi.org/10.5281/Keywords:
Tumor Necrosis Factor-alpha, Tuberculosis Spinal, SpondylitisAbstract
Background: Osteoarticular tuberculosis represents 9-20% of extrapulmonary forms and spinal tuberculosis is its most common form.
Clinical cases: We present three cases of tuberculous spondylitis in patients aged 22, 36 and 68 years, with 8, 6 and 6 months of evolution and with involvement of L5-S1, T7-T8 and T5-T6, respectively. The two younger patients had disc involvement, and in the first case a pyogenic abscess was initially suspected. Local pain was the initial symptom and the 2 older patients developed inability to walk and urinary and fecal incontinence. The patients received a complete anti-tuberculosis regimen and the postoperative evolution was satisfactory. All showed expression of tumor necrosis factor in the epithelioid and giant cells of the granulomas and activation of nuclear factor κβ in the accompanying lymphocytes.
Conclusions: The persistence of localized spinal pain, with or without local volume increase, should alert the physician to the possibility of a spinal infectious process, including tuberculosis.
Downloads
References
WHO. Global tuberculosis report 2022. (consultado 2023, Agosto 24). Disponible en: https://iris.who.int/bitstream/hand le/10665/363752/9789240061729-eng.pdf?sequence=1.
Ramírez-Lapausa M, Menéndez-Saldaña A, Noguerado-Asensio A. Extrapulmonary tuberculosis: an overview. Rev Esp Sanid Penit 2015;17: 3-11.
León-Rubio I, Espejo G. Decrease in osteoarticular tuberculosis in Spain between 1997 and 2018. Reumatol Clin (Engl Ed). 2023;19(1):45-48. doi: 10.1016/j.reumae.2022.06.003.
Garg D, Radhakrishnan DM, Agrawal U, et al. Tuberculosis of the Spinal Cord. Ann Indian Acad Neurol. 2023;26(2):112-126. doi: 10.4103/aian.aian_578_22.
Sternbach G. Percivall Pott: tuberculous spondylitis. J Emerg Med. 1996;14(1):79-83. doi: 10.1016/0736-4679(95)02053-5.
Tuli SM. Tuberculosis of the spine: a historical review. Clin Orthop Relat Res. 2007;460:29-38. doi: 10.1097/BLO.0b013e318065b75e.
Glassman I, Nguyen KH, Giess J, Alcantara C, Booth M, Venketaraman V. Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott›s Disease. Clin Pract. 2023;13(1):155-165. doi: 10.3390/clinpract13010014.
Liu X, Zheng M, Sun J, et al. A diagnostic model for differentiating tuberculous spondylitis from pyogenic spondylitis on computed tomography images. Eur Radiol. 2021;31(10): 7626-7636. doi: 10.1007/s00330-021-07812-1.
Khanna K, Sabharwal S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J. 2019;19(11): 1858-70.
Ansari S, Amanullah MF, Ahmad K, et al. Pott’s Spine: Diagnostic Imaging Modalities and Technology Advancements. N Am J Med Sci. 2013;5:404–411. doi: 10.4103/1947-2714.115775.
Tanaviriyachai T, Choovongkomol K, Pornsopanakorn P, et al. Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis. Int J Spine Surg. 2023:8522. doi: 10.14444/8522.
Garg B, Mehta N, Mukherjee RN, et al. Epidemiological Insights from 1,652 Patients with Spinal Tuberculosis Managed at a Single Center: A Retrospective Review of 5-Year Data. Asian Spine J. 2022;16:162-172. doi: 10.31616/asj.2021.0137.
Jain AK, Rajasekaran S, Jaggi KR, et al. Tuberculosis of the Spine. J. Bone J Surg Am. 2020;102:617-628. doi: 10.2106/ JBJS.19.00001.
Abaynew Y, Ali A, Taye G, et al. Prevalence and types of anemia among people with tuberculosis in Africa: a systematic review and meta-analysis. Sci Rep. 2023;13(1):5385. doi: 10.1038/ s41598-023-32609-1.
Albuquerque VVS, Kumar NP, Fukutani KF, et al. Plasma levels of C-reactive protein, matrix metalloproteinase-7 and lipopoly-saccharide-binding protein distinguish active pulmonary or extrapulmonary tuberculosis from uninfected controls in children. Cytokine. 2019;123:154773. doi: 10.1016/j.cyto.2019.154773.
Tang L, Liu S, Bao YC, et al. Study on the relationship between vitamin D deficiency and susceptibility to spinal tuberculosis. Int J Surg. 2017;44:99-103. doi: 10.1016/j.ijsu.2017.05.077.
Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions. Orthop Surg. 2023;15 (6):1454-1467. doi: 10.1111/os.13744.
Sia JK, Rengarajan J. Immunology of Mycobacterium tuberculosis Infections. Microbiol Spectr. 2019;7(4):10. doi: 10.1128/ microbiolspec.
Li T, Bian H, Wang R, et al. Study on the expression level of NFκB and clinical evaluations in spinal tuberculosis patients. Cell Mol Biol (Noisy-le-grand). 2022;67(4):135-142. doi: 10.14715/ cmb/2021.67.4.16.
Medina-Peñasco RJ, Rosas-Ramírez MI, Barragán-Hervella RG, et al. Tuberculosis de columna vertebral: experiencia en un hospital de tercer nivel en Puebla, México. Rev Med Inst Mex Seguro Soc. 2017;55 Suppl 1:S80-S84.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Revista Médica del Instituto Mexicano del Seguro Social
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.
